This form can be used by anyone to anonymously alert school counselors of friends who are contemplating suicide, who show signs of suicidal tendency, or who are making decisions that are harmful (such as cutting, drug abuse, alcohol abuse, abusive relationship, etc.). The purpose of this alert is to get help, not to get anyone in trouble. For that reason, this alert goes directly to the counselors in your building not to building or district administration.

* Required

Who is the person about whom you are concerned? *

Your answer

What is this person doing that has caused you to become concerned? *

Your answer

It may be helpful for counselors to contact you for more information. If you are comfortable with that, please provide your name. This is optional.